AAP: Distinguish bleeding disorder from abuse

Pediatricians and other pediatric health care providers should first determine whether bruising or bleeding in a child is associated with a bleeding disorder before suspecting child abuse, advises the American Academy of Pediatrics (AAP) in a new clinical report on evaluating bleeding disorders and abuse in children.

The report cautions that an inappropriate diagnosis of child abuse could result in the removal of the child from his or her home and possibly prosecution of an innocent parent or caregiver. Conversely, attributing an abusive injury to medical or accidental causes could put the child at risk for future abuse and even death.

Patient history, physical examination, and clinical evaluation help clinicians to decide whether laboratory testing for bleeding disorders is needed. The report recommends a pathway of diagnosis and evaluation for a medical condition as the primary cause for bleeding or bruising; suggests laboratory testing strategies based on the prevalence of the symptoms and patient history; and offers markers for deciding when follow-up consultation with a pediatric hematologist is warranted.

The report also points out that evidence of a bleeding disorder does not rule out abuse, nor does a history of trauma or abuse exclude the possibility of a bleeding disorder.

A technical report released in conjunction with the clinical report reviews some of the congenital and acquired medical conditions that predispose children to bleeding or bruising. The researchers acknowledge that the list is extensive, but they say there are large databases for rare hematologic conditions that, when modified to include the factors relevant to the case being examined, can assist clinicians in making the correct diagnoses.